Hysteroscopic Removal of Intrauterine Contraceptive Device During the First Trimester. Procedure Description and Pregnancy Outcomes

Abstract

Study Objective To evaluate the efficacy and safety of intrauterine contraceptive device (IUD) removal during the first trimester for desired pregnancies. Design prospective cohort study. Setting single tertiary, university affiliated, medical center. Patients or Participants 7 first trimester gravid women who underwent hysteroscopic removal of an IUD at an operating room (OR) setting. Interventions After sonographic evaluation of the IUD location, as well as gestational age and vitality, patients were transferred to the OR. All 7 IUD removals were performed in vaginoscopic approach without any anesthesia or cervical dilation using 3.5mm Gynecare Versascope (Ethicon). Prior to the procedure, all patients received a single dose of intravenous prophylactic antibiotic (Cefamezine), vagina was washed with an antiseptic solution. After clear intrauterine view was achieved using 0.9% normal saline solution, instillation of fluid was stopped in order to decrease the risk for hydro-dissection of the gestational tissue. IUD was removed using semirigid 5F grasping forceps (Karl-Stortz, Tuttlingen, Germany). Ultrasound examination at the end of procedure was performed to ensure fetal pulse. Measurements and Main Results All IUD were copper covered, timing of IUD extraction was between 6-9 weeks of gestation. All 7 pregnancies carried on after the procedure. In our cohort, all 7 women delivered at term (37-42 weeks). All deliveries were spontaneous vaginal deliveries of healthy babies at appropriate weight for gestational age (2859-3756gr). No marked complications during pregnancy or delivery were noted. Conclusion Hysteroscopic removal of IUD in the first trimester is a safe procedure not linked to major adverse pregnancy outcomes. This procedure should be offered to gravid women in the first trimester who desire to preserve pregnancy.